Metastatic Merkel Cell Carcinoma of the Pancreas: A Case Report

Background: Merkel cell carcinoma (MCC) is a malignant primary cutaneous neuroendocrine tumor with high propensity for local recurrence and distant metastasis. It commonly involves skin, brain, bone, liver and lung. Distant metastasis to the gastrointestinal tract, including pancreas, is very rare.Presentation of Case: In this article we report a case of a 59 year old male with history of left gluteal skin MCC which presented with metastatic involvement of body of pancreas 5 months after the diagnosis of primary tumor.Conclusion: Although MCC metastases to pancreas is rare, it should be kept in mind in patients with abdominal complaints and past history of MCC

Skin Sparing Mastectomy and Immediate Breast Reconstruction (SSMIR) for early breast cancer: Eight years single institution experience

Abstract Background Skin Sparing Mastectomy (SSM) and immediate breast reconstruction has become increasingly popular as an effective treatment for patients with breast carcinoma. The aim of this study was to evaluate the clinical outcome of skin sparing mastectomy in early breast cancer at a single population-based institution. Methods Records of ninety-five consecutive patients with operable breast cancer who had skin-sparing mastectomy and immediate breast reconstructions between 1995 and 2003 were reviewed. Patient and tumor characteristic, type of reconstruction, postoperative complications, aesthetic results and incidence of recurrence were analyzed. Results Mean age of the patients was 51.6(range 33–72) years. The AJCC pathologic stages were 0 (n = 51, 53.7%), I (n = 20, 21.1%), and II (n = 2, 2.1%). Twenty of the patients had recurrent disease (21.1%). The immediate breast reconstructions were performed with autologus tissue including latissimus dorsi musculocutaneous flap in 63 (66.3%) patients and transverse rectus abdominis myocutaneous (TRAM) flap in 4 (4.2%) patients. Implants were used in 28 (29.4%) patients. The average hospital stay was 7.7 days. Flap complication occurred in seven (10.4%) patients resulting in four (6%) re-operations and there were no delay in accomplishing postoperative adjuvant therapy. At a median follow-up of 69 months (range 48 to 144), local recurrence was seen in one patient (1.1%) and systemic recurrence was seen in two patients (2.1%). Conclusion Skin sparing mastectomy and immediate breast reconstruction for early breast cancer is associated with low morbidity and low rate of local recurrence.</p

Clinical improvement of diabetes mellitus type 1 by b-D-mannuronic acid (M2000) in a breast cancer patient — as a case report

A 56 years old female with breast cancer (BC) and poor controlled diabetes mellitus type 1 (DM1) which has registered in a clinical trial for assessment of thera­peutic efficacy of b-D-mannuronic acid (M2000) on pre-surgical BC patients is described in this case report. After receiving M2000, the patient was followed for 9 weeks. During this period, cancer mass details, fast­ing blood glucose (FBG) levels, 2-hour post-prandial blood glucose (2HPP), blood uric acid (BUA) level and urine analysis (UA) were continuously controlled. After 9 weeks of treatment with M2000, her FBG, BUA and UA decreased significantly. This finding was exactly in accordance with our published experimental data about the anti-diabetic effect of M2000 in an animal model. Therefore, it might be concluded that M2000 is probably able to improve DM1 by reducing FBG level, BUA level, glycosuria, ketonuria and proteinuria

Primary breast lymphoma (PBL) in men — a systematic review

Primary breast lymphoma (PBL) is a rare type of lymphoma, especially in men. Details of the clinical course are not well recognized, and a consensus on the treatment of PBL in male is not available. The objective of presenting this study was to find the most common presentation and the best treatment options for male PBL by collecting and analysing data of all reported cases published between 1985 and 2019. A comprehensive search in Google Scholar, Ovid Medline, PubMed, and Scopus databases for any case of PBL presenting in men between 1985 and 2019 was performed. Patient information such as age, diagnosis, type of treatment(s), time to follow-up and patient status were recorded. A total of 28 studies containing data of 34 male patients with PBL were included in this review. The mean age of patients was about 61 (range: 26–85) years. The mean tumour size was 46.05 ± 20.37 mm. The majority of cases were presented with a palpable breast mass (unilateral or bilateral). Nine patients (26.5%) had previous comorbidities. Diffuse large B cell lymphoma was the most common histologic diagnosis (85.3%). Treatment consisting of systematic therapy combined with radiotherapy showed benefit outcome. The results of the analysis showed that the response to different therapies was better in younger patients with PBL. It seems that systemic therapy combined with at least a 30 Gy dose of radiation has the best outcome in male patients with PBL. Considering limited data in each group of treatment modality, further follow-up studies in these patients are necessary

Abnormal anti-Müllerian hormone level may be a trigger for breast cancer in young women: A case-control study

Background: Anti-Müllerian hormone (AMH) is a known sensitive biomarker for fertility and ovarian reserve. The results of in vivo and human studies showed inconsistency with respect to the relation between AMH and breast cancer. Objective: To compare the AMH level of young Iranian women with early breast cancer who have not received any treatment compared to that of healthy women. Materials and Methods: In this case-control study, 58 breast cancer cases were recruited from the breast oncology clinic of two university hospitals. They were diagnosed with an in situ or invasive breast cancer before any anticancer treatment between August 2018 and April 2019. Healthy controls (n = 58) were selected from women referred to a gynecologic outpatient clinic without any symptoms of cancer or infertility. AMH was measured by the AMH enzyme-linked immunosorbent assay kits in one laboratory. Results: Final analysis showed that the AMH means of case and control were not statistically significant (3.36 ± 2.95 vs 3.13 ± 1.79). However, the lower and higher AMH level categories are more prevalent in breast cancer compared to the control. Pearson’s correlation test showed that the AMH level was negatively correlated with age (r = -0.44, p&lt; 0.001). The results of logistic regression analysis considering confounding factors showed the positive association between breast cancer and lower (Odds Ratio [OR] = 5.98, p = 0.02) and higher quartile of AMH level (OR = 4.95, p = 0.01). Conclusion: Our results suggest that abnormal AMH level is more frequent in young breast cancer patients. Further investigation considering AMH determinants is required. Key words: Anti-Müllerian hormone, Breast cancer, Biomarkers, Ovarian reserve

The Role of Open Diagnostic Peritoneal Lavage in the Evaluation of Peritoneal Cytology for Advanced Gastric Cancer: An Old Diagnostic Modality with New Usage

Background: Positive peritoneal cytology is a critical factor in prognosis. Peritoneal lavage is associated with long-term survival in patients with gastric cancer. Diagnostic peritoneal lavage (DPL) is a method for diagnosing visceral injury in trauma patients. This study aimed to investigate the usage of DPL in staging the work-up of patients with gastric cancer. Method: In this prospective study, we enrolled gastric cancer patients referring to Cancer Institute; they underwent DPL and washing specimen was sent for cytology review. After DPL, all patients underwent staging laparoscopy (SL) via the same abdominal incision. Results: DPL and SL were successful in all patients. There were six (11%) cases of peritoneal seeding discovered in SL; all of these patients had positive peritoneal cytology on DPL. Also, four patients showed positive cytology in the absence of positive SL. Thus, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of DPL were 100 % (95% CI: 54.1-100), 91.6 % (95%: 79.2-97.5), 100 % (95%CI: 85.3-100), and 60 % (95%CI: 37-79.3). The accuracy of DPL in determining the peritoneal dissemination of gastric cancer was 92.31% (95% CI: 81.5-97.9). Conclusion: DPL had an excellent ability to find peritoneal dissemination in a gastric cancer patient, which is of great value in the setting of low-resource countries

Cervical mature teratoma 17 years after initial treatment of testicular teratocarcinoma: report of a late relapse

BACKGROUND: Late relapses of testicular germ cell tumor are uncommon. We report a case of cervical mature teratoma appeared 17 years after treatment of testicular teratocarcinoma. CASE PRESENTATION: A 20- year- old patient underwent left sided orchiectomy followed by systemic therapy and retroperitoneal residual mass resection in 1989. He remained in complete remission for 200 months. In 2005 a huge left supraclavicular neck mass with extension to anterior mediastinum appeared. Radical surgical resection of the mass was performed and pathologic examination revealed mature teratoma. CONCLUSION: This is one of the longest long-term reported intervals of a mature teratoma after treatment of a testicular nonseminoma germ cell tumor. This case emphasizes the necessity for follow up of testicular cancer throughout the patient's life

Clinical Breast Cancer Registry of IR. Iran (CBCR-IR):Study Protocol and First Results

BACKGROUND: Breast cancer (BC), as a significant global health problem, is the most common cancer in women. Despite the importance of clinical cancer registries in improving the quality of cancer care and cancer research, there are few reports on them from low- and middle-income countries. We established a multicenter clinical breast cancer registry in Iran (CBCR-IR) to collect data on BC cases, the pattern of care, and the quality-of-care indicators in different hospitals across the country.METHODS: We established a clinical cancer registry in 12 provinces of Iran. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During this registry, we studied the clinical characteristics and outcomes of patients with cancer who were admitted from 2014 onwards.RESULTS: We registered 13086 BC cases (7874 eligible cases) between 1.1.2014 and 1.1.2022. Core needle biopsy from the tumor (61.25%) and diagnostic mammography (68.78%) were the two most commonly used diagnostic methods. Stage distribution was 2.03% carcinoma in situ, 12% stage I, 44.65% stage II, 21.32% stage III, and 4.61% stage IV; stage information was missing in 1532 patients (19.46%). Surgery (95.01%) and chemotherapy (79.65%) were the most common treatments for all patients.CONCLUSION: The information provided by this registry can be used to evaluate and improve the quality of care for BC patients. It will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran.</p

Is Increase of Homocysteine, Anti-Cardiolipin, Anti-Phospholipid Antibodies associated with Breast Tumors?

Patients with malignancy are at higher risk of thrombotic complications due to the hypercoagulability state. Our objective in this study was to assess the serum concentrations of Homocysteine, anti phospholipid antibodies, and anti cardiolipin in patients with benign and malignant breast tumors and study the effect of chemotherapy on the serum levels of these markers. A case control study was carried out on 100 women with malignant breast tumor and 100 age matched control with benign breast tumors.Serum concentrations of heomocystein, anti cardiolipin antibody (IgG and IgMaCL) and anti-phospholipid antibody (IgG and IgMaPL) were measured in all cases. The malignant group was followed for six months, and serum levels of abovementioned markers were measured again after surgical removal of breast tumor and chemotherapy. Current results showed a significantly higher serum concentration of Homocysteine, IgG and IgMaPL, IgG and IgM aCL in patients with malignant tumor before chemotherapy compared with benign tumor patients. We found a significant decrease in these markers after chemotherapy (P Value<0.05).We propose performing these tests (Homocysteine, IgG and IgM aPL, aCL) in patients with breast malignancy and starting prophylactic anti-thrombotic treatment in those with high serum levels of the markers. In addition, since the serum levels of the markers in patients with malignancy reduce after adjuvant therapies, we strongly recommend using adjuvant chemotherapy in these patients